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Facet Joint Syndrome – Jenny L.F. Andrus, MD

By Orthopaedic & Spine Center

Facet (pronounced “Fah-set”) joints are bony connectors of one vertebra to another. Each spinal level contains two facet joints; one on either side of the spine. These joints guide and limit the amount of spinal movement. Like other joints in the body, they can get inflamed as a result of injury or arthritis. This may cause stiffness, pain and loss of function.

Symptoms
Specific symptoms depend on the location of the affected joint and the degree to which the nerves are affected.
• People who suffer from facet joint syndrome in their necks often have headaches and complain that they cannot turn their heads and must turn their entire body to look to the right or left.
• If the facet joint syndrome is in the back, it can cause pain in the lower back, buttocks or thighs.
• It can become challenging to stand up straight or get out of a chair.
• Typically, there is more discomfort when leaning backward than when leaning forward.
• Pain does not have to be constant but may come and go.

Diagnosis
The most important part of diagnosis of facet joint syndrome is your description of your pain. A diagnostic X-ray, MRI, or CT scan is useful in looking for arthritis or other degenerative changes that may be associated with facet joint syndrome. Often facet joint related pain is diagnosed through a facet joint injection or a medial branch nerve block. In a facet joint injection, live x-ray imaging called fluoroscopy is used to guide the needle into the joint. Numbing medication as well as steroid is injected. This injection can be useful for diagnosis as well as treatment. A more definitive way however to diagnose facet joint pain is a procedure called a medial branch block. The medial branch nerve supplies feeling to the facet joint. This nerve can be numbed with local anesthetic to determine if that relieves the pain. If the patient’s pain goes away after the injection, it can be inferred that the pain generator is the facet joint.

Treatment
Treatment of facet joint pain often includes medications, physical therapy as well as interventional procedures. Proper back mechanics and maintaining a healthy weight are also important. Treatment of facet joint syndrome may include:

• The use of Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs. They are often the first line medications used to treat pain and reduce inflammation caused by arthritis, tendonitis, and bursitis. NSAIDs are inexpensive and effective. There are side-effects associated with NSAIDs, such as upset stomach, ulcer, and possible interference with kidney function. Severity of the side effects may increase the longer a patient takes NSAIDs. Many people do experience significant relief when taking this medication.

• Physical Therapy – Successful long-term treatment often involves physical therapy. A therapist will work with a patient to create a program to include a series of stretches and strengthening exercises. There are many stretching exercises for relieving pain and elongating the spine that will help ease discomfort. Therapists will work with the patient to strengthen the core and lower back muscles. Most importantly physical therapist will give guidance on the ways to move and perform daily activities in a more comfortable manner.

• Exercise – Many patients see relief after beginning an exercise program on top of the physical therapy. Also maintaining a healthy weight is important for spine health.

• Facet joint injections—The facet joint can be injected with steroid and numbing medications. This is a very effective way to treat pain from inflammation of the facet joint. Using fluoroscopy a needle is carefully inserted into the joint and medication injected. This procedure should only be done with image guidance to insure the correct needle location. This procedure is done in the office and takes only a few minutes. For many patients this will provide several months of relief. This procedure can be repeated if necessary.

• Medial branch radiofrequency ablation– The medial branch nerve supplies the feeling to the facet joint. It is a small nerve and is not responsible for leg strength. This nerve may be temporarily numbed with local anesthetic during a procedure called a medial branch block. If a person has significant pain relief with this block we can infer that the facet joint is the cause of the pain. We may then proceed with a radiofrequency procedure. This procedure damages the nerve so that it cannot send the pain signal. This is a relatively simple procedure that is done in the office. This can provide very good long term pain relief.

Jenny L.F. Andrus, MD, is a Fellowship-trained, Board-certified, Interventional Pain Management Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Dr. Andrus was named a Top Doc for 2014 by Coastal Virginia Magazine. For more information about Dr. Andrus and her practice, go to www.osc-ortho.com . For an appointment, call 757-596-1900.